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Unstable urethra as defined by the International Continence Society is the condition where loss of urine is caused solely by a fall in urethral pressure. But the condition is rare and therefore the term Urethral Pressure Variations (UPV) is better used. The UPV are caused by activity of smooth and striated muscles. Frequently is associated with Genuine Stress Incontinence or Detrsor Instability that can make worse urinary loss. An urogynecologic work-up can reveal the presence of UPV by Urodynamic and ultrasound evaluations. The Urethral Pressure monitoring reveals the fast or slow intraluminal pressure fall between 10 to 20 cm H2O or more. The ultrasound examination carried out by a linear vaginal probe (5 MHz) can observe the contraction of the "prepubic muscle" (anterior pubo-urethral ligament + bulbo-spongious muscle) as a preliminary phase of urethral pressure fall. The prepubic muscle located from clitoris to the external meatus exert a force on the anterior and distal part of the urethra during the intraluminal pressure falls. With the section of this structure (muscle + ligament) we treated 9 patients diagnosed as having UPV with concomitant irritative urologic symptoms. Out of 9 women with a follow-up ranged from 1 to 23 months (mean 9,5), 5 patients (56%) were cured, 2 (22%) of them were improved, in the last 2 (22%) patients no change was observed. The complications were minimal only a vestibulo-vaginal increased sensitivity, and one case of dyspareunia.(ABSTRACT TRUNCATED AT 250 WORDS)

A total of 11 women with stress urinary incontinence related to intrinsic sphinteric incontinence (type 3) underwent periurethral injection of autogolous fat. The fat was harvested from the abdominal wall by special liposuction unit including: a special syringe for plastic surgery provided with 6 straight needles 12-20 Gauge connected to a vaum extractor for the liposuction; a 14 Gauge straight needle for lipofilling periurethrally and then a cystoscope with a 0 degree and 70 degree lenses. The fat is injected at 3 and 9 o'clock position and the mean quantity was 15,5 ml. The exact localization of the injected area was endoscopically detected before, and afterwards with an ultrasound transrectal probe. Follow up results were assessed clinically and by urodinamic and ultrasound evaluation at 3, 6 and every six months following. A follow up was ranged from 9 to 36 months (mean 22.6). Of the 11 women, 6 (54.5%) were cured, 2 (18.2%) pats. Were improved and in 3 woman (27.3%) no change occurred. The Urodynamic parameters didn't show any statistical significant change except for Functional Urethral Length (p < 02) and Flow Time (p < 04) that increased in cured patient. The ultrasound evaluation showed an hyperecogenic aspect in all patients; and al the urethral wall was hyperecognic in 1 woman. The resorption average time was 8 months, and 8 pats (72.7%) showed a partial resorption after 22 months. 3 patients should have been reinjected, 2 of them were cured and in the last one an improvement was observed.(ABSTRACT TRUNCATED AT 250 WORDS)